Quality improvement report submission template

This template is structured around writing up an improvement report. It is based on the

SQUIRE guidelines for best practice in writing up quality improvement projects.

Please write your own text entry in each blank section, ensuring you follow the guidance
given.

Title: Indicate that the article concerns an initiative to improve healthcare.

Text entry

Abstract: This is a summary of your work and is the most important section to attract a
reader's attention. Please ensure you include a brief background to the problem, the
method for your quality improvement project, the overall results and conclusion. Keep it
succinct and factual.

A good example of an abstract can be found below. The maximum length of your abstract
should be 300 words. Please note that the BMJ house style does not use headings or
bullet points for abstracts. There is a good example of an abstract in this paper entitled;
Improving diagnosis for congenital cataract by introducing NGS genetic testing

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Problem: In this section you will need to summarise your problem and the focus of your
project. You will need to outline your SMART aim for your project (for example; the aim
was to reduce medication errors from 15% to 5% across six elderly care wards in three
months).

Give some details about your local context including; the type of organisation you work in,
the size of your organisation, details about the staff members who work there and perhaps
a little bit about your local patient population. It might be useful for others to include how
you got started with this project and what drove you to tackle this problem. There is a good
example in this paper entitled; Making the journey safe: recognising and responding to
severe sepsis in accident and emergency

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Background: This section gives the reader background information about the problem and
provides up-to-date, research and knowledge from the literature.

Summarise the literature you have found on the background t your problem here. What
existing evidence is there that this problem exists? What evidence is there that other
people have tried to solve this problem in the past? Is there any evidence for what works
and what doesn't to solve your problem? There is a good example in this paper entitled; A
change of culture: reducing blood culture contamination rates in an Emergency
Department.

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Measurement: Describe which measures you selected for studying processes and the
outcomes of the intervention(s), including rationale for choosing them, their operational
definitions, and their validity and reliability. Describe how you planned to collect this data
throughout your project and how frequently. Outline how you planned to establish if the
observed outcomes were due to your interventions.

You must also include here, the results of your baseline measurement. There is a good
example in this project entitled; Improving communication between phlebotomists and
doctors: a quality improvement project.

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Design: Describe the intervention (or series of interventions) that you planned to
implement to improve the quality of care you deliver. Describe any reasons or assumptions
that were used to develop the intervention(s) and reasons why you expected them to work.
Outline how you consulted/engaged with your team members or organisations. Who was
in your project team? Did you anticipate/predict any problems at this stage? Describe how
you planned to make your intervention sustainable.

This step is critical for others to understand the thinking behind the development of your
intervention.

There is an example in this article entitled; Improving asthma severity and control
screening in a primary care pediatric practice.

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Strategy: In this section you should explain your strategy for improvement to the reader
and discuss how you implemented your improvement cycles. In most cases you will have
tried a number of progressive improvement cycles, some of which will not have been
successful. It is important that you also share these to help others avoid similar
difficulties.Remember that data should be collected continuously throughout your project.

This is a difficult section to document and will contain a lot of information. For each PDSA
cycle you should describe your aim, your change hypothesis and strategy for change.
Describe how you implemented the change and the data you collected. Describe your key
learning from each cycle of change, and discuss how this learning impacted on your
change process. How well did your predictions of what change was needed match your
outcomes? What worked more effectively than anticipated and what had less effect than
predicted?

There is a good example in this paper entitled; “The constipation conundrum”: Improving
recognition of constipation on a gastroenterology ward

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Results: Provide a summary of what your results and run-chart/control chart showed.
Describe the variation in your data. Were the interventions you made responsible for any
improvements? Describe how contextual elements interacted with the intervention(s) and
affected your results. Compare your results to your baseline measurement.
Comment on how you assessed whether the data was complete and accurate- was there
any missing data? Please comment on whether there were any unintended consequences
such as unexpected benefits, problems, failures or costs associated with the
intervention(s).

There is an example from this paper entitled; Low stimulus environments: reducing noise
levels in continuing care. Run-chart available here.

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Lessons and limitations: In this section, discuss the lessons you learnt from the project
and it's limitations. Comment on the strengths of the project. Describe any problems you
faced and how you navigated these. If you were to undertake this project again, what
would you do differently?

Reflect on your project's limitations. For example, did you realise as the project was
implemented that your results would be affected by unforeseen factors such as a small
sample size or the turnaround of patients or staff? Comment on the limits of
generalisability. Describe whether chance, bias, or confounding have affected your results
and whether there was any imprecision in the design or analysis of the project. Are more
data points required? Were efforts made to minimise/adjust for any limitations?

Although we accept publications using different improvement approaches, we would

expect you to have modified your intervention as it was implemented and undergone a
process of continuous improvement, measurement and learning. If your project does not fit
with this approach then we would like to see reflections and learning here about how you
could have incorporated continuous improvement and measurement approaches in your
project. There is an example which can be found in this project entitled; Improving
communication between phlebotomists and doctors: a quality improvement project.

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Conclusion: You should reflect on your background research, noting what is already
known on this topic and what your project adds. You should refer back to your aims
statement – did your project achieve its aims? Did you adjust your aims as you went
along? Was it a useful project? Were your measures appropriate and did you use
balancing measures? Think about what your senior sponsor would like to see as an output
of your work and what can help others to make the case for undertaking a similar piece of
work – or for doing something differently if your project was not successful. Please
describe your cost analysis here, were there any financial savings that your project made?
Being able to demonstrate that your intervention delivered savings really helps to add
value.

Give an assessment of whether you think your project is sustainable- do you have enough
data? What have you done to try to ensure that your work continues? Comment on how
you would spread your project and whether it could be replicated elsewhere. Discuss what
your next steps will be and whether further study in the field is required.
The point of the conclusion is not to rewrite the whole project, but to give an overview of
how the whole project was conducted, what it achieved, and some personal reflections.
There is an example from this paper entitled; Making the journey safe: recognising and
responding to severe sepsis in accident and emergency.

Text entry

References: In this section you should record any references to published material that
you refer to elsewhere in your project. This is particularly likely to include material from
background reading or from your conclusions.

The BMJ uses the Vancouver style for referencing. There is an example from this paper
entitled; Implementing mobile devices to reduce non-rostered workload for junior doctors
or click here for a comprehensive guide to referencing.

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Acknowledgements: Please include here the names of anyone who is not on the author list
but whose input you wish to acknowledge.

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